Inside MMH: Obstetrics

INSIDE MMH: Obstetrics

The Service We Wish We Still Had — and the Reality Behind Rural Labor & Delivery

There is one question we hear from our community perhaps more than any other when discussing services at McCurtain Memorial Hospital:

Why don’t we deliver babies anymore?

It is a fair question. More importantly, it comes from a place we understand.

For families who have welcomed children at this hospital, for mothers who remember giving birth here, and for generations who have watched McCurtain Memorial Hospital play a role in some of the most important moments of their lives, the loss of Labor & Delivery is deeply personal.

It is personal to us, too.

So, as part of our Inside MMH series, we want to talk openly about obstetrics—not to make excuses, not to dismiss the concern, and certainly not to suggest that Labor & Delivery is unimportant.

Quite the opposite.

If there were one service line we could simply choose to bring back tomorrow, Labor & Delivery would be at the top of our list.

But understanding why that has not happened requires understanding something most people outside healthcare never have reason to see: what it actually takes to safely operate a Labor & Delivery department in a small rural hospital.

And before we explain the numbers, we first need to tell the story of one extraordinary physician.

For Many Years, His Name Was Dr. William Herron

For decades, McCurtain County had something increasingly rare in rural America.

We had local obstetrical care.

As a Critical Access Hospital, McCurtain Memorial was providing a service that had already disappeared from many hospitals like ours across Oklahoma and the United States.

And the truth is that our program was largely built upon the extraordinary commitment of Dr. William “Bill” Herron.

There really is no way to tell the history of obstetrics at McCurtain Memorial Hospital without telling his story.

For years, Dr. Herron essentially carried this program on his shoulders.

Except for approximately five days each year, Dr. Herron made himself available around the clock—day after day, night after night, weekend after weekend and holiday after holiday.

Babies do not look at a clock before deciding to enter this world.

They come at 2:00 in the afternoon and 2:00 in the morning. They come on Christmas. They come during thunderstorms. They come when roads are covered in ice. They come while everyone else is sitting down for Thanksgiving dinner.

And for years, when that call came in McCurtain County, Dr. Herron answered it.

Even more remarkable, Dr. Herron’s arrangement was extraordinarily favorable to this hospital. He did not charge MMH simply to remain on call for obstetrical coverage. He separately billed for his professional services when delivering a baby, while the hospital billed for the facility services associated with the hospitalization.

That model allowed a small rural hospital to maintain something that would be extraordinarily difficult to replicate today.

Then life changed.

When Dr. Herron’s wife, Kim, became seriously ill, he understandably needed to step away from the enormous commitment the program required.

A husband needed to be with his wife.

The hospital suddenly faced a reality that had been hidden by Dr. Herron’s extraordinary dedication for years:

Replacing Dr. Herron was nearly impossible.

We tried.

In our determination to preserve the service, the hospital recruited another physician. That relationship ultimately was not the right fit for the hospital or the community. Federal and state privacy and employment laws appropriately limit what we can say about personnel matters, and we will respect those obligations.

But even having another physician did not solve the larger problem.

There were still periods when adequate physician coverage could not be maintained, forcing the hospital to go on obstetrical divert. In other words, even though we technically maintained the program, there were times patients still had to be transferred elsewhere because safe 24-hour coverage was unavailable.

What we eventually came to understand was that we were not simply looking for another obstetrician.

We were trying to find another Dr. Herron.

And there may never be another one.

What Does It Actually Take to Keep Labor & Delivery Open?

This is the part of rural healthcare most people never see.

A Labor & Delivery department cannot open at 8:00 a.m. and close at 5:00 p.m.

A hospital cannot tell a mother in labor, “Come back Monday.”

An emergency C-section cannot wait until the anesthetist arrives tomorrow morning.

If a hospital represents to its community that it provides obstetrical services, it must build the clinical infrastructure necessary to respond when a mother and baby need it.

Oklahoma hospital standards require an organized obstetrics/gynecology service with appropriately credentialed physicians on call and immediately available 24 hours a day, and a dedicated obstetrics unit available 24 hours a day. (Welcome to Oklahoma’s Official Web Site)

And rural hospitals across America face exactly the same staffing dilemma we faced. The American Hospital Association describes a rural OB model delivering roughly 300 babies annually that requires at least two Labor & Delivery nurses around the clock, together with CRNA capacity, C-section first-assist capacity and acute newborn-provider coverage 24 hours a day, 365 days a year. (AHA)

Consider what just a portion of that infrastructure costs.

Two Labor & Delivery nurses, every hour of every day

Using an average wage of $34 per hour:

2 nurses × 24 hours × 365 days × $34 = $595,680 per year

That is before benefits.

Anesthesia coverage

Using an average CRNA cost of $100 per hour for continuous coverage:

24 hours × 365 days × $100 = $876,000 per year

Again, before benefits and other employment costs.

Physician coverage

A sustainable obstetrical program cannot reasonably be built around expecting one physician to surrender virtually every night, weekend, holiday and vacation indefinitely.

That was the extraordinary sacrifice Dr. Herron made.

A more sustainable call rotation would require multiple physicians. Using three OB/GYN physicians at just $275,000 each:

3 × $275,000 = $825,000 per year

And $275,000 is hardly an extravagant assumption. The U.S. Bureau of Labor Statistics reported a national mean annual wage of approximately $279,040 for obstetricians and gynecologists in May 2025. (Bureau of Labor Statistics)

Add those three basic staffing categories together:

Labor & Delivery nurses: $595,680CRNA coverage: $876,000Three OB/GYN physicians: $825,000

Total: $2,296,680 per year.

And please understand what that number does not include.

It does not include employee benefits.

It does not include malpractice insurance.

It does not include additional nursing coverage for vacations, illness, FMLA, education or turnover.

It does not include operating-room personnel necessary for emergency C-sections.

It does not include surgical first-assist coverage.

It does not include newborn resuscitation and pediatric/newborn coverage.

It does not include laboratory services, pharmacy, blood products, respiratory therapy, fetal monitoring equipment, infant warmers, bassinets, emergency equipment, medications, supplies, housekeeping, dietary services, utilities, maintenance, continuing education or administrative overhead.

It does not include the enormous cost of maintaining a department capable of responding to an emergency whether a baby is born that day or not.

That last point is critical.

About 225 Babies a Year

When our obstetrical program was operating, McCurtain Memorial delivered approximately 225 babies per year.

That is a meaningful number of families.

But financially, there is another way to look at it.

There are 8,760 hours in a year.

Two hundred twenty-five deliveries average approximately 4.3 deliveries per week—or roughly one delivery every 39 hours.

But the department cannot be staffed once every 39 hours.

It has to be ready during all 8,760 hours.

There may be a day with three deliveries.

There may be another day with none.

There may be a night when every Labor & Delivery room is quiet.

But the nurses still must be there.

Anesthesia still has to be available.

Physician coverage still has to exist.

Emergency surgical capability still has to be available.

That is the fundamental economic challenge of low-volume rural obstetrics: you are not simply paying for deliveries. You are paying for readiness.

Using only the three staffing categories above, $2,296,680 divided among 225 annual deliveries equals approximately:

$10,207 per delivery.

And remember—that is before benefits and before virtually every other expense associated with operating the department.

This is not an accounting theory unique to McCurtain Memorial.

The American Hospital Association reports that rural hospitals consistently identify three primary reasons for closing obstetric units: staffing challenges, declining or low patient volume, and inadequate reimbursement. The AHA further reported that hospital Labor & Delivery services had an average margin of approximately negative 18% across all payers in 2023. (AHA)

In other words, hospitals across America are losing money providing the very service communities desperately need.

And Then There Is Medicaid

Medicaid is particularly important to this discussion because Oklahoma Medicaid—SoonerCare—finances an enormous share of births in our state.

Oklahoma maternal-health data show that nearly 57% of Oklahoma live births were covered by Medicaid in 2023. (MCHB Tvis Data)

That means reimbursement policy is not an abstract government issue for rural Labor & Delivery departments.

It can determine whether those departments survive.

SoonerCare reimburses inpatient hospital stays under its Diagnosis Related Group, or DRG, methodology, generally paying the lesser of billed charges or the applicable DRG amount, with additional provisions for qualifying high-cost outlier cases. (Welcome to Oklahoma’s Official Web Site)

There is also an important distinction between what the physician receives and what the hospital receives. They are not the same payment.

For perspective on the professional side, an Oklahoma Health Care Authority rate proceeding in 2025 listed physician pricing associated with CPT 59400—routine obstetric care including vaginal delivery—at approximately $2,063, because the proposed licensed-midwife payment of $1,650.73 represented 80% of physician pricing. That professional payment encompasses substantially more than simply walking into a delivery room and delivering a baby; Oklahoma Medicaid’s obstetrical billing rules historically bundled routine maternity care into the total obstetrical-care payment when applicable. (Welcome to Oklahoma’s Official Web Site)

The hospital’s facility reimbursement is separate and depends on the patient’s DRG and other reimbursement factors. For that reason, it would be misleading for us to publish one number and claim, “This is what Medicaid pays MMH for every delivery.”

What we can say with certainty is this:

The cost of maintaining a Labor & Delivery program exists 365 days a year. Reimbursement arrives only when patients receive billable services.

That distinction matters enormously in a hospital delivering 225 babies rather than 2,000 or 3,000.

This Is Bigger Than McCurtain Memorial

Perhaps the most important thing we want our community to understand is that McCurtain Memorial Hospital is not alone.

This is a rural healthcare crisis.

The March of Dimes reports that 51.9% of Oklahoma counties are maternity-care deserts—counties without a birthing facility and without obstetric clinicians. Another 18.2% have low or moderate rather than full access to maternity care. (March of Dimes)

Even more striking, current March of Dimes data indicate:

66.2% of Oklahoma counties have no hospital or birth center offering maternity care.

March of Dimes

Oklahoma’s own maternal-health reporting shows the number of birthing hospitals in this state fell from 57 in 2015 to 43 in 2024. (MCHB Tvis Data)

University of Minnesota Rural Health Research Center data show that between 2010 and 2023, 10 Oklahoma counties lost all hospital-based obstetric services. By 2023, approximately 68% of rural Oklahoma counties had no hospital-based obstetric services. Among Oklahoma’s least-populated rural counties—those without a town larger than 10,000—an astonishing 93% lacked hospital-based obstetrical services. (MN Rural Health Research Center)

This is not happening because rural hospitals suddenly stopped caring about mothers and babies.

It is happening because the economics and workforce behind rural obstetrics have become extraordinarily difficult.

Nationally, more than 267 rural hospitals stopped providing obstetric services between 2011 and 2021. By 2023, only about 45% of rural hospitals continued offering Labor & Delivery. (AHA)

And the problem continues.

ACOG reported in late 2025 that more than 100 rural hospitals had closed their Labor & Delivery units just since 2020. (ACOG)

Now Add the Rural Hospital Crisis

There is another reality a physician considering McCurtain County has to consider.

The physician isn’t simply asking:

“Do I like the community?”

He or she is also asking:

“Will this hospital still be here?”

That is painful to write, but pretending otherwise does nothing to help rural healthcare.

Just this month, an August 2026 report based on Center for Healthcare Quality and Payment Reform data identified 45 Oklahoma rural hospitals as being at risk of closure, placing Oklahoma among the states with the largest number of vulnerable rural hospitals. (KOKH)

Other recent analyses have produced different totals depending upon methodology—one reported 63 of Oklahoma’s 73 rural inpatient hospitals as financially at risk, including 18 at immediate risk. The precise numbers vary because the definitions and financial tests vary, but every serious analysis points toward the same conclusion:

Rural hospitals are under extraordinary financial pressure.

AOL.com

The Oklahoma Hospital Association has warned that upcoming Medicaid reductions could cost Oklahoma hospitals approximately $6.7 billion over the next decade, with rural hospitals expected to be particularly vulnerable. (KGOU)

National data tell the same story. Chartis reports that since 2010, 206 rural hospitals have either closed or converted to models that no longer provide inpatient care. Oklahoma has lost inpatient hospital care through 13 closures or conversions—one of the highest totals in the nation. (Chartis)

Imagine, then, that you are a young OB/GYN.

You have spent approximately four years in college, four years in medical school and another four years in an OB/GYN residency.

You may have substantial student debt.

You are deciding where to establish your career, where to purchase a home, where your spouse will work, where your children will attend school and where you may spend the next 20 or 30 years of your life.

A large health system may offer you several partners with whom to share call, extensive specialist backup, a NICU, established surgical teams and the financial security of a large organization.

Then a small independent rural hospital calls.

We may offer a wonderful community.

We may offer grateful patients.

We may offer meaningful work.

But if we are asking that physician to become the next Dr. Herron—to carry a tremendous call burden while rural hospitals throughout the state are publicly being described as financially vulnerable—we have to acknowledge how difficult that recruitment proposition is.

That is not an excuse.

It is the reality of rural physician recruitment in America.

When We Closed OB, We Were Fighting to Save the Hospital

There is another part of this story that our community deserves to understand.

When McCurtain Memorial made the painful decision to discontinue Labor & Delivery, this hospital was fighting its way out of millions of dollars in debt.

We faced decisions no hospital administrator, Board member, physician, nurse or community ever wants to face.

We had to ask whether maintaining one deeply important service line could jeopardize every other service the hospital provided.

The Emergency Department.

Inpatient care.

Laboratory.

Imaging.

Surgery.

Clinics.

Hundreds of jobs.

And ultimately, the hospital itself.

Leadership sometimes requires choosing between two things you desperately want to keep.

Closing Labor & Delivery did not mean we believed mothers and babies were unimportant.

It meant we were unwilling to allow the loss generated by one service to potentially contribute to losing the entire hospital.

That decision hurt.

It still does.

We are sorry that women in our community must travel outside McCurtain County for planned hospital deliveries.

We are sorry that grandparents cannot always drive a few minutes down the road to meet their newest grandchild.

We are sorry that another piece of rural healthcare disappeared from our community.

And we understand why people want it back.

We want it back, too.

Getting Out of Debt Did Not Solve the Workforce Problem

As McCurtain Memorial’s financial condition improved, another question naturally followed:

“If the hospital is doing better financially, why don’t you reopen OB?”

Because money is only one part of the equation.

We still need the people.

One physician cannot reasonably be expected to live the life Dr. Herron lived indefinitely.

A sustainable program needs a call rotation. It needs physicians who can cover one another when someone becomes sick, takes vacation, attends continuing education, has a family emergency—or simply wants to attend their child’s birthday without wondering whether their phone will ring.

That means recruiting multiple physicians, not simply finding one.

And the shortage is real.

ACOG has specifically warned that clinician shortages are affecting obstetric units nationwide and that maintaining adequate physician, midwife and nurse staffing is especially difficult in rural areas. (ACOG)

This is why simply saying, “Hire an OB,” does not solve the problem.

We have to find one.

Then another.

Then another.

We have to convince them to relocate to rural southeastern Oklahoma.

We have to provide a sustainable call schedule.

We have to maintain anesthesia, nursing, surgery and newborn capabilities around them.

And we have to build a program they believe will still exist years from now.

That is a much larger challenge than writing a job posting.

Maybe Now We Understand What Dr. Herron Gave This Community

Perhaps this conversation also gives us an opportunity to recognize something extraordinary.

For years, McCurtain County had what many communities never had:

Dr. Bill Herron.

The numbers tell us how remarkable his commitment really was.

We talk today about needing multiple physicians to create a sustainable call rotation.

Dr. Herron largely was the rotation.

For years.

Day after day.

Night after night.

Christmas after Christmas.

He delivered generations of McCurtain County babies while allowing this little rural hospital to provide a service that hospitals across Oklahoma were already struggling to maintain.

There are physicians who practice medicine.

And every once in a while, a community is fortunate enough to have a physician who becomes part of its history.

Dr. Herron is part of ours.

We hope this community never forgets what he gave to it.

And He Still Answers the Call

Although McCurtain Memorial no longer operates a traditional Labor & Delivery department, pregnancy does not stop at the hospital doors.

Babies occasionally have plans of their own.

When an expectant mother presents to our Emergency Department and delivery is imminent, our hospital does not turn her away.

Our providers and clinical staff maintain the training and equipment necessary to respond to emergency deliveries, stabilize mothers and newborns, and arrange higher-level care when necessary.

And yes—Dr. Herron still delivers babies when an emergency requires him to do so.

After all these years, when his community truly needs him, he still answers.

That probably tells you more about the man than anything we could write.

We Have Not Forgotten Our Mothers

To the women of McCurtain County:

We hear you.

When you tell us you wish you could deliver your baby here, we understand.

When you tell us traveling for delivery is frightening or inconvenient, we understand.

When families tell us they miss the days when babies were born at McCurtain Memorial Hospital, we understand.

We do not dismiss those concerns.

We share them.

And we are sorry.

But we also owe you more than promises we cannot safely or responsibly keep.

We owe you the truth.

The truth is that rural obstetrics is disappearing across Oklahoma and America.

The truth is that reimbursement has struggled to keep pace with the cost of maintaining these programs.

The truth is that rural hospitals are facing historic financial pressure.

The truth is that OB/GYN recruitment is extremely difficult.

The truth is that maintaining Labor & Delivery means maintaining an entire clinical infrastructure every minute of every day—even when no baby is being delivered.

And the truth is that for many years, McCurtain County overcame many of those challenges because one remarkable physician was willing to give a level of commitment that simply cannot be expected of another human being.

His name is Dr. William Herron.

We will never stop looking for opportunities to strengthen healthcare in McCurtain County. And should a financially and clinically sustainable path emerge that allows us to safely restore obstetrical services, it is a conversation we would welcome with open arms.

Because there is something special about a hospital that gets to care for a person from his or her very first breath.

We miss that.

We know you do, too.

And perhaps that is the most important thing we can tell you:

McCurtain Memorial did not stop delivering babies because we stopped caring about mothers and children.

We stopped because, at that moment in our history, preserving that one service threatened our ability to preserve the hospital that serves them throughout the rest of their lives.

It was one of the hardest choices we had to make.

We remain sorry that it had to be made.

And while we cannot promise when—or whether—the enormous financial and workforce barriers surrounding rural obstetrics will allow traditional Labor & Delivery to return, we can promise something else:

We will never stop believing that the mothers and babies of McCurtain County deserve exceptional care.

And we will never forget the physician who spent decades proving just how much one person could give to make that possible.

Thank you, Dr. Herron.

Inside MMH is an educational series from McCurtain Memorial Hospital designed to give our community a clearer understanding of rural healthcare—its challenges, its opportunities, its people and the decisions required to preserve local access to care.